“We must learn to reawaken and keep ourselves awake, not by mechanical means, but by an infinite expectation of the dawn.” Henry David Thoreau
Returning from the recent Aqua conference, I found myself re-reading Audre Lorde’s essay ‘Uses of the Erotic: The Erotic as Power’. Her understanding of the erotic as a wellspring of vitality, integrity, and connection shone a harsh light on the current state of our health and care systems. We speak of compassion, psychological safety and culture, yet we operate through frameworks that undermine them. We rehearse the language of care while living the logic of control.
Health and care leadership has become enthralled by performance management: dashboards, inspections and league tables. These are not neutral tools but rather instruments of cultural formation. When they dominate, care is hollowed out. People learn to perform adequacy rather than offer real care. One clinician recently told me: “I have to document so much to prove I’m being compassionate, I barely have time to actually be compassionate”.
This reveals a deep contradiction: the very frameworks designed to assure quality often erode the conditions that make quality care possible. They offer the appearance of improvement while inducing moral injury, exhaustion, and fear. This performance culture is not simply flawed but incompatible with the relational and imaginative heart of care.
From metrics to meaning: a call for care
What is needed now is a reclamation of imagination. Not fantasy but a moral, active, and relational imagination. One that allows us to see beyond metrics and to feel the sacred in the mundane, to sense what care truly asks of us.
Joan Tronto, writing on the ethics of care, reminds us: “To care well, we must be able to imagine the position of the other, to see the world as she sees it.” Without this imaginative capacity, care becomes a task, not a calling.
Leaders too, must reimagine their role. We cannot simply translate policy into practice. We must interrogate the premises on which policy is built. When those at the top prioritise power over purpose, the whole enterprise is in trouble.
Leading politics through care
It is time to move from managing the politics to leading them. To stand up against performance assessment frameworks that damage staff and diminish care. To say: we will no longer comply with a logic that hollowed out Mid-Staffordshire. We must build buffers against dehumanisation and we must protect the spaces where care can breathe.
This means seeing care systems not as machines to be optimised, but as living ecologies. From this perspective, leadership is not engineering but cultivation. The role of the leader is not to drive performance but to nurture vitality.
We must recover the soul of care – not as sentiment, but as the animating principle that gives our work meaning. Iain McGilchrist reminds us that our dominant culture is driven by the left hemisphere’s hunger for certainty and control. In turn, it has lost touch with the right hemisphere’s capacity for relationship, presence and depth. Reclaiming imagination is not an indulgence. It is an ethical and operational necessity.
What might this look like in practice?
- Staff meetings that begin in silence or with poetry.
- Reflective space built into rotas, not as a luxury but as leadership.
- Dialogue circles instead of compliance briefings.
- Joy, awe, and attunement recognised as indicators of quality.
We need a system where leaders protect people, not spreadsheets. Where compassion isn’t something earned after the metrics are met, but the ground from which all action begins.
The NHS cannot be saved by performance. It can only be saved by care. And care begins when someone dares to say: not this. No longer. No more.
Let us be those people.
